title: Community-acquired methicillin-resistant Staphylococcus aureus pneumonia: a clinical audit.
abstract: OBJECTIVE
  Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains are primarily associated with skin and soft tissue infections; however, they are increasingly causing more invasive infections including severe community-acquired pneumonia. The objective of this study was to describe the clinico-pathological characteristics of community-acquired MRSA pneumonia.
  
  
  METHODS
  A retrospective analysis of case records from January 2002 to August 2008 was performed on patients admitted with community-acquired MRSA pneumonia to two large teaching hospitals.
  
  
  RESULTS
  Sixteen patients with community-acquired MRSA pneumonia were identified. Their age ranged from 11 months to 86 years (median age; 30 years). Duration of symptoms before hospital presentation ranged from one to 21 days. Most patients had productive cough, fever and dyspnoea. The most common radiological presentation included multilobar consolidation (8/16), necrotizing consolidation (7/16) and empyema (5/16). Seven patients required intensive care support; four required ionotropic support and five required mechanical ventilation for a mean duration of 53 h and 6.6 days, respectively. Six patients underwent surgery (VATS or open thoracotomy). There was a mean delay of approximately 69 h (range; 18 h to 11 days) after presentation before appropriate MRSA antimicrobial treatment was initiated. Three patients died of complications from pneumonia, all within 72 h of presentation. Among survivors, the average length of hospital stay was 23.8 days (range; 10-49 days). Majority of survivors were left with mild residual radiological changes.
  
  
  CONCLUSIONS
  Community-acquired MRSA pneumonia is increasing and should be suspected in patients with severe community-acquired pneumonia. There was a delay in initiation of appropriate antimicrobial treatment that could have lead to increased morbidity.
authors.affiliation: Department of Respiratory and Sleep Medicine, John Hunter Hospital, New South Wales, Australia. drrajeshthomas@rediffmail.com
authors.forename: Rajesh
authors.initials: R
authors.lastname: Thomas
authors.forename: John
authors.initials: J
authors.lastname: Ferguson
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Coombs
authors.forename: Peter G
authors.initials: PG
authors.lastname: Gibson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D013207:Staphylococcal Skin Infections / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents